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Outpatient Care, Vaccination, Can Prevent Complications For Patients With SLE
Almost one-quarter of patients with systemic lupus erythematosus (SLE) require hospitalization each year, often for conditions that could be prevented by consistent primary care and vaccinations, researchers reported.
The investigators reviewed US Medicaid claims from 29 states during the period 2000–2010, identifying 45,654 Medicaid beneficiaries with SLE aged between 18 and 65 years, with 12 months of enrollment before the first code for SLE. They then examined the use of acute care—defined as emergency department (ED) visits or hospital discharges—for vaccine-preventable illnesses, including influenza, pneumococcal disease, meningococcal disease, herpes zoster, high-grade cervical dysplasia/cervical cancer, and hepatitis B.
“We estimated the incidence rate of vaccine-preventable illnesses and used Cox regression to assess risk (with hazard ratios and 95% confidence intervals) by sociodemographic factors and health care utilization, adjusting for vaccinations, comorbidities, and medications,” the authors noted.
Among the identified Medicaid beneficiaries with SLE, 1,290 patients had 1 or more visits or hospitalizations for a vaccine-preventable illness (6.6 per 1,000 person-years); 93% of events occurred in unvaccinated patients. Less than 10% had billing claims for vaccinations. Black patients had a 22% higher risk of requiring acute care for vaccine-preventable illnesses than did White patients. More outpatient visits were associated with lower risk of these illnesses and of requiring acute care.
“Medicaid beneficiaries with SLE who are not vaccinated are at risk for potentially avoidable acute care use for vaccine-preventable illnesses,” the researchers reported. “Racial disparities were noted, with a higher risk among Black patients compared to White patients. Greater outpatient use was associated with reduced risk, suggesting that access to ambulatory care may reduce avoidable acute care use.
--Rebecca Mashaw
Reference:
Feldman CH, XuC, Costenbader KH. Avoidable acute care use for vaccine-preventable illnesses among Medicaid beneficiaries with lupus. Arthritis Care Res. 2021;9(73):1236-1242
